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Bicondylar Tibial Plateau Fractures: What Predicts Infection?
Nathan Olszewski1, Givenchy Manzano, Eleanor Wilson
1From the Boston Medical Center, Boston, MA, (Olszewski, Tornetta III), MetroHealth Medical Center , Cleveland, OH, (Manzano, Wilson, Joseph, Vallier), Stony Brook University, Setauket- East Setauket, NY, (Pawlak, Kottmeier), University of Houston, Houston, TX, (Adam Miller, Gary), Washington University, St. Louis, MO, (Namm, Anna Miller, Gupte), Vanderbilt University Medical Center, Nashville, TN, (Rodriguez-Buitrago, Obremskey), the Division of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington, MA, (Willier III, Marcantonio), The Ohio State Wexner Medical Center, Columbus, OH, (Phieffer, Sheridan), Carolinas Medical Center, Charlotte, NC, (Li, Karunakar), Mayo Clinic, Rochester, MN, (Vargas-Hernandez, Yuan), the Department of Orthopaedics (Shapiro, Pratson), University of North Carolina, Chapel Hill, NC, Oregon Health & Science University, Portland, OR, (Friess, Jenkins), Dalhousie University-Halifax, Canada, (Leighton, Alqudhaya, Aljilani), Indiana University Orthopedics, Indianapolis, IN, (Mullis, Gruenwald), Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, (Ollivere, Myint), University Alabama Birmingham, Birmingham, AL, (Odom, Spitler), LSUHSC Department of Orthopaedic Surgery, New Orleans, LA, (Suwak, Shah), and the Geisinger Musculoskeletal Institute, Danville, PA (Rocha, Horwitz).
Objectives:
The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists.
Design:
Retrospective review.
Setting:
Eighteen academic trauma centers.
Patients/Participants:
A total of 1,287 patients with 1,297 OTA type 41-C bicondylar tibia plateau fractures who underwent open reduction and internal fixation were included. Exclusion criteria were follow-up less than 120 days, insufficient documentation, and definitive treatment only with external fixation.
Intervention:
Open reduction and internal fixation.
Main Outcome Measurements:
Superficial and deep infection.
Results:
One hundred one patients (7.8%) developed an infection. In multivariate regression analysis, diabetes (DM) (OR [odds ratio] 3.24; P ≤ 0.001), alcohol abuse (EtOH) (OR 1.8; P = 0.040), dual plating (OR 1.8; P ≤ 0.001), and temporary external fixation (OR 2.07; P = 0.013) were associated with infection. In a risk-adjusted model, we found center variation in infection rates (P = 0.030).
Discussion:
In a large series of patients undergoing open reduction and internal fixation of bicondylar plateau fractures, the infection rate was 7.8%. Infection was associated with DM, EtOH, combined dual plating, and temporary external fixation. Center expertise may also play a role because one center had a statistically lower rate and two trended toward higher rates after adjusting for confounders.
Level Of Evidence:
Level IV-Therapeutic retrospective cohort study.
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